Dr. Thompson's Blog

New U.S. Whopping Cough (Pertussis) Deaths

An article in the June 24, 2010 New York Times by Jesse McKinley gave the scary statistic that there have been five recent whooping cough deaths in babies all under three months of age. In addition, 910 other cases of pertussis have been confirmed and several hundred more are under investigation. There are concerns that whooping cough may now reach epidemic proportions in unimmunized children,

Babies should receive their first DPT immunization at two months. None of the babies had been immunized which is a tragedy. Now even older people are getting whooping cough. A doctor friend's mother who was in her seventies nearly died from her bout with whooping cough.

As a child of three or four, I spent one summer whooping. I coughed so much and so loudly that the neighbors complained I kept them awake at night. How nice it would have been if immunizations were available against pertussis when I was a baby or small child. That is not a summer I want to remember. At least I survived unlike the five babies who have just died. How sad that the parents either didn't have access to medical care or were afraid to let their babies have  DPT immunizations.

Now that Dr. Andrew Wakefield's medical license has been revoked in Britain, I hope more parents will start having their children immunized. Dr. Wakefield was the man who started the concerns about immunizations and autism. He created a terrible problem and parents who really care about their children need to re-think their stand on immunizations if their children are not protected.

Treatment of Bladder and Kidney Infections

Over the years I have heard many accounts of individuals, particularly women, having  difficulty getting adequate treatment for kidney and bladder infections. Women in particular have more problems because of the possiblity of contamination from stool and sexual intercourse. This last week I was talking with the husband of a women who had such a severe bladder infection that she had to be admitted to a hospital. She became so upset by the medical treatment she received in the hospital that she had to be discharged with medication for anxiety, The doctors and nurses seemed much more interested in her diabetes than her urinary problems. Although her diabetes had been under control for many years, the doctors kept ordering blood sugars and other tests, but paid little attention to her bladder infection.

The woman was discharged on the antibiotic, Cipro, and told that it would take several weeks for her infection to clear. No information was given about a repeat urine culture, a follow-up visit with a urologist, or any other follow-up information. Since the bladder infection  was apparently not responding to Cipro I suyggested that she needed another urine culture and a change in antibiotics. She also needed to see a urologist for follow-up.

How sad that anyone should be so upset by the care they receive in a hospital that they have to be put on anxiety medicine. The husband said. "I guess these days no one should go to the hospital without an advocate." I agreed and said that one of the reasons I wrote 101 Ways To The Best Medical Care was to help people learn how to get adequate medical care and how to find an advocate. I have several good Web sites listed for advocates in the many pages of resources in the back of the book.

Summer Safety for Kids

Many parents dread summer because of having to find ways to keep their kids occupied and safe.  Emergency rooms see far too many kids as a result of accidents, burns, or beach and pool accidents with near-drownings.

Laura Wright sent me a good list of ways to keep kids occupied and asked me to share it. I am sure it will be helpful to many parents. It is http://associatedegreeonline.com/blog/2010/06/kids-summer-activity-list-100-creative-and-cheap-summer-activities-for-your-kids/

If your child gets into a poisonous substance, it is important to have the number of the National Poison Hotline posted by all your telephones. it is 1-800-222-1222. If children are going to be playing outdoors, parents should be good about putting on sunscreen. However, the recommendation is that sunscreen should not be used until a child is at least six-months-old. Little children get burned by the sun very easily, so hats are important, as are unbrellas at the beach. I always shudder when I see little ones out in the hot sun with no hats. The other important safety precaution is to be sure that children and teens wear helmets when biking, roller blading, or on the back of parents' bikes. The parents too should wear helmets. Many times I have seen parents on bikes without  helmets while their children have on helmets. If the parents are hit by a car or have an accident on their bikes, what is a little child supposed to do? One report said that one in four children do not wear bike helmets.

Playground equipment injuries in one report accounted for 200,00 injuries. Trampolines are extremely dangerous and the American of Academny of Pedatrics advises parents never to buy one or allow the use of one at a friend's home. Hopefully, some to these tips will keep at least a few chidlren away from the emergency rooms or doctors' offices.

What Constitutes a Child's Yearly School or Camp Physical

In my Blog yesterday about Avoiding Store Mini-Clinics, I did not have space to add what should be done on a child's camp or school annual physical. One of the most important things is to have the child undressed down to shorts or underwear with a gown offered if desired. No physical examination should ever be done on anyone without the patient undressed. Next a detailed history should be taken and immunizations checked. If a child's tetanus shots are not up-to-date and he or she has an injury at camp or a serious burn, this information is very important to know. A urinalysis should be done to check for diabetes or kidney disease and a basic blood count is important.

If a child arrives at camp with undetected diabetes and develops problems, there could be serious consequences. Also, if a child has an elevated or abnormal blood count and is sent to a camp which lasts a week or longer, there could also be problems.

I did a routine urinalysis on a child who was not feeling well, but had plans to go on vacation with her family,. The urinalysis was negative, but something made me ask the mother to bring the girl back the next day. I was afraid I might be missing something, even though I couldn't find anything on physical examination. The next day, I asked for another urine specimen, but, her mother said, "You did one yesterday." "Yes," I said, "but I want another one and I won't charge you."

When the girl handed me her urine specimen, I saw a urine that was dark brown. Under the microscope I could see many  red blood cells and knew  she had a serious kidney disease or glomerulonephritis. If my patient had left on vacation or gone to camp there could have been serious consequences. Fortunately, with treatment there were no bad effects, but there certainly could have been if I had not asked for the second urinalysis. This is not the kind of care that can occur at a store Mini-Clinic and the American Academy of Pediatrics, of which I am a Fellow, has spoken out strongly against these clinics for kids.

Avoid Store Mini-Clinics for Children

I was in a big chain drug store this morning and saw a sign advertising a Mini-Clinic. As I walked by the room where the "clinic" was located, I saw a young woman clad in a white coat. The room she was in was the size of a very small kitchen or bathroom. I saw a chair, but no examining table. I also suspect there were no gowns for the patients. Outside the small room were two parents or grandparents and a child who was about eight-years-old. The adults were filling out a form under a sign saying  "Camp Physical   Examinations-$35." I shuddered as I walked quickly by remembering some of the major problems I have found on the many camp physical examinations I have done.

Sending a child to an overnight camp should not be done without careful planning. Part of that planning should be to be sure that a child does not have any physical or serious emotional problems. If someone doing the physical examination knows nothing about the family history or has not seen a child before, a great deal can go undetected. Also, these These clinics are not staffed by M.Ds, but by nurse practitioners.

i remember a child  I knew well whose parents wanted to send her to a Wilderness Camp. These are camps where a child is left alone with minimal survival tools. I knew of the girl's emotional problems and was unwilling to sign the form. I felt such a wilderness experience could put her in great danger. The parents were quite upset that I would not sign the form. Instead, they took the form to a friend who was an internist and a single man. The doctor had no knowledge of the child and probably didn't have  a lot of experience with children. He signed the form and the child went off to camp. The parents did not know that I made a long distance call to the camp director and explained my fears about the girl. The director said they would take special precautions and was very appreciative I had called. Yes, they were concerned about the child, but they also could have  been liable if anything had happened to her. My advice to parents (and grandparents in-charge) is please do not seek any medical care for your children at store Mini-Clinics. Your child and you could pay a high price.

 

Choosing Medical Care By Cost

In yesterday's New York Times, an article by Claire Cain Miller discusses a new company, Castlight Health. The purpose of the company is to let people chose medical care by cost. I cannot believe that a physician and  the Cleveland Clinic, who are helping to finance the company, would think this is a good idea.

A good example of this is a friend in her mid-seventies who takes two expensive overseas trips a year and yet settles for HMO care. She is told what doctors to see, but when she gets into trouble she has to pay to see to an outside doctor or go to the ER. I would love to take two overseas trips a year, but instead pay for insurance that allows me to go to any doctor I chose. I would never, ever, let a physician touch me without thoroughly researching his or her credentials.

I should think that  Dr.Cotella, the co-founder of Castlight, would know that every laboratory and every physician are not of the same quality. When I received an abnormal lab result on a patient I would usually have the test repeated at another laboratory. I soon found that for certain procedures there were labs I could not trust. Other physicians have told me they have the same experience.  Choosing a doctor who charges the least for a colonoscopy makes little sense. There can be bad side effects if the physician is hurried or has had little experience with the procedure. The friend I mentioned had such an experience with an HMO gastroenterologist who did a colonoscopy. Even that experience  did not convince her to pay for adequate health insurance. Choosing medical care by cost is an extremely bad idea. I hope the company re-thinks their mission.

Undetected Mental Health Problems in Kids

The American Academy of Pediatrics has started a long overdue campaign to get pediatricians to detect mental health problems in children in their early years. This is something that I  have  long advocated and about which I feel very strongly. the AAP notes that there are fourteen million children with some kind of mental health problem. This equals one in five kids.

An article on June first in the Wall Street Journal by Shirley Wang noted that 21% of chidlren in the U.S. have a diagnosable mental health problem, but only one-fifth of these receive any treatment. I would add that a large number of these kids are also undetected. Included in the mental health category are attention-deficit disorders, autism, and anxiety. Now that 1:150 kids are being diagnosed in the autism spectrum, early detection and treatment is a must. However, if the average physician sees a patient for just 8.5 minutes and doesn't get the know the families or the kids, how can they possibly pick up mental health disorders? Our whole medical system is completely broken. Hopefully, some of the provisions in the new healthcare bill will pay for detection and treatment of more kids with mental health issues. However, since pediatricians are the least well paid of any specialty, something will have to be done to allow them to bill for spending more time with patients.

Government Bans Health Claims for Some Kellogg Cereals

Because cold cereal was never part of my breakfast as a child and not part of my children's or grandchildren's breakfasts, I have not paid attention to advertisments for some of Kellogg's cold cereals. As a pediatrician, I was remiss in not knowing about claims Kellogg was making for Frosted Mini-Wheats and Rice Krispies.

According to an article by Sewell Chan in today's New York Times, the Federal trade Commission has ordered Kellogg to remove the advertisments for Frosted Mini-Wheats stating that the cereal was "clinically shown to improve kids' attentiveness by nearly 20% percent. " If anything the sugar content of the cereal would make many children hyperactive and less attentive. I have never  been able to eat cold cereals because the high sugar content always gives me a headache.

The article also noted Kellogg claimed that Rice Krispies "now helps support your child's immunity". This is an amazing statement that I can't believe any reputable company would make without substantial scientific proof. I am delighted that the government has now banned this kind of advertising.

I think all children need a breakfast that includes some good protein: oatmeal, yogurt, eggs, sausage, or bacon. I had one patient with spina bifida who lived on a diet of Fruit Loops. The mother was having a very difficult time controlling his diarrhea. I suggested she eliminate the Fruit Loops and offer some good protein containing foods and the diarrhea stopped. Our diet does make a great difference in how we feel and how our bodies function.

When a Little Child Is Not Saying Words

I think one of the things that bothers me most about the current practice of pediatrics is how nonchalant some pediatricians and family doctors are about a little child not saying several words by age two.

I was talking to a woman last week who expressed concern about her two-year-old grandson. She said  he seemed bright, but wasn't saying any words. I asked her if the child's hearing had been checked and she said "No". She promised that she would insist it be done and said she would send me a follow-up.

Of course, there are several reasons a small child does not talk, but the very first thing parents should do is to have a pediatric ear-nose-and throat doctor check that there is not impacted wax in the ear canals or bilateral ear infections. There may also be what is called "glue ears" for infections that have been present for a long time. Many doctors these days keep on giving antibiotics to little children with ear infections and the infections never clear up, but just stay in the middle ear.

According to the National Institute of Deafness, twelve thousand babies are born yearly with some hearing loss. Unforunately, not all states check newborns' hearing and any test can give false results.

Children with developmental delay, autism, and other disorders may not have early speech. I have seen two little children who communicated just by screaming. One mother of a screamer said the little child spoke  a few words, but I have concerns that he may have a problem other than screaming. The other child had obvious developmental delay.